MRCP Part 2 Category: Neurology

MRCP2-3314

A 75-year-old male presents to his GP complaining of a crawling sensation in his legs and an urge to move them, especially at night. These symptoms have been present for six months and have worsened over the last two months, causing daytime sleepiness. The patient has a history of hypertension, which is managed with atenolol and ramipril. He quit smoking 10 years ago and drinks 20 units of alcohol per week. He lives alone and has limited family support.

During examination, the patient’s blood pressure was 158/88 mmHg, pulse was 80/min and regular, and heart sounds were normal. Scratch marks were observed on his lower limbs, but tone, power, and reflexes appeared normal with flexor plantar responses. All pulses were present and easily palpable, and abdominal examination was normal.

Investigations revealed a haemoglobin level of 101 g/L (130-180), mean cell volume of 72 fL (80-96), white cell count of 9.2 ×109/L (4-11), and platelets of 285 ×109/L (150-400). Serum sodium was 138 mmol/L (137-144), serum potassium was 4.2 mmol/L (3.5-4.9), serum urea was 5.1 mmol/L (2.5-7.5), serum creatinine was 90 µmol/L (60-110), fasting plasma glucose was 4.5 mmol/L (3-6), and serum cholesterol was 5.1 mmol/L (<5.2). What would be the appropriate management plan for this patient?

MRCP2-3330

A 78-year-old male was brought into hospital after waking with left arm weakness predominantly affecting the hand with a left sided facial droop in an upper motor neuron pattern. His blood pressure on admission was 170/85 mmHg and his heart rate was 75 beats per minute and in sinus rhythm. His blood glucose level on admission was 7.5 mmol/L.

His initial CT brain showed some mild bi-temporal atrophic change and some chronic small vessel ischaemia without any acute ischaemic changes and in particular, no haemorrhage.

He was admitted with a suspected diagnosis of minor ischaemic stroke. Which of the following imaging modalities will confirm the diagnosis?

MRCP2-3315

A 20-year-old female presents to the Emergency Department after experiencing a seizure. She has no significant medical history but has been complaining of a severe headache for the past few hours. On examination, she appears confused and is holding her head in her hands. Her GCS is 13/15 (M6 V4 E3), and there are no focal neurological deficits. Her pulse rate is 90/min, and she has a temperature of 37.2º. No neck stiffness is noted. A CT scan with contrast is ordered. What is the most likely diagnosis?

MRCP2-3316

A 57-year-old Asian woman came to the clinic with a gradual onset of difficulty swallowing and hoarseness for the past year. She also reported a persistent dry cough for the past two years. Upon examination, she had nasal-sounding speech, reduced left-sided gag reflex, weakened palate, and left-sided tongue atrophy with deviation to the left. All other cranial nerves were normal, and there were no abnormalities in her limbs. What is the probable diagnosis?

MRCP2-3301

A 55-year-old woman has been referred to you due to a personality change that has been ongoing for a year. She has become loud, sexually flirtatious, and behaves inappropriately in social situations. Additionally, she has been experiencing difficulties with memory and abstract thinking, although her arithmetic ability remains intact. There is no motor impairment, and her speech is relatively preserved. What is the most probable diagnosis?

MRCP2-3302

A 55-year-old woman presents to a neurologist with episodes of loss of consciousness. She has already been evaluated by a cardiologist and had normal results on an echocardiogram and a fitted loop recorder. Her symptoms begin with an occipital headache that subsides, followed by dizziness, double vision, and dysarthria. Some episodes result in complete blackouts and twitching of all four limbs. She has also experienced incontinence during one episode. On examination, she has hypertension treated with bendroflumethiazide and a right carotid bruit. Blood tests reveal elevated cholesterol and glucose levels. What is the most likely diagnosis for this patient?

MRCP2-3303

A 65 year old man presents to the Emergency Department after experiencing a sudden and severe headache while watching television. He became confused and drowsy, and suffered a tonic-clonic seizure upon arrival. The patient has a history of hypertension, hypercholesterolaemia, and a non-ST elevation myocardial infarction. His compliance with anti-hypertensive medications has been inconsistent. On examination, the patient is drowsy but protecting his own airway. Initial investigations reveal elevated blood pressure and mild small vessel disease. Further imaging shows bilateral symmetric vasogenic oedema involving the subcortical white matter in the parietal-occipital, posterior temporal and posterior frontal lobes. What is the correct diagnosis?

MRCP2-3304

A 65-year-old man with a history of Type 2 diabetes for the past 10 years presents for a check-up. He is currently managing his diabetes with BD mixed insulin and has been experiencing increasing pins and needles and pain in both feet over the past year. In addition to his diabetes, he has a history of a previous myocardial infarction and intermittent urinary retention over the past year, which has been diagnosed as benign prostatic hypertrophy by his GP. On examination, his blood pressure is 150/85 mmHg, his pulse is regular at 75 beats per minute, and he has peripheral neuropathy affecting both feet, which are numb up to the ankle. Routine blood tests, including renal function, are normal.

What is the most appropriate course of action for this patient?

MRCP2-3305

A 70-year-old man presents to the neurology outpatient department with a gradual onset of tremor as referred by his primary care physician. He has a medical history of hypertension and recurrent falls and is currently taking amlodipine. He denies smoking or alcohol consumption.

During the examination, the patient displays bradykinesia and rigidity, along with a pill-rolling tremor in his right hand. He is unable to perform vertical saccades with his eyes and appears to lean forward while walking.

What is the probable diagnosis?

MRCP2-3306

A 78-year-old male has been referred to your Parkinson’s disease clinic by his GP. The patient and his wife have reported an increase in falls, with the most alarming incident occurring last week when he fell down 4 steps of stairs, fortunately without any lasting harm. During the examination, you observe a slow pill rolling tremor present on both hands and bilateral cog-wheeling. The patient’s cranial nerves appear normal, except for a lack of upwards gaze. His speech is clear but has a nasal quality. What is the most probable diagnosis?